Republic of the Philippines

Cordillera Administrative Region

Province of Abra
2x2
2x2
Governor DADS EAP (Educational Assistance Program) ID PICTURE
ID PICTURE
Application Form

Instructions: Please read the General and Documentary Requirements. Fill in the required
information. Do not leave an item blank. If item is not applicable, indicate “N/A”.

PERSONAL INFORMATION

NAME
(Last Name) (First Name) (Middle Name)

Date of Birth (mm/dd/yy)

Permanent
Place of Birth Mailing Address
Male
Sex
Female Zip Code

School Name
Civil Status Single Married

Citizenship School Address

Mobile Number
School Type Public Private
E-mail Address

Type of Course & Year

Disability (if any)
FAMILY BACKGROUND
Father : Living Deceased Mother: Living Deceased
Name
Address
Occupation
Educational Attainment
Annual Gross Income of Parents

(Signature over Printed Name of Applicant) Date Accomplished

Evaluated/Processed by: Approved by:

DADS EAP Coordinator DOMINIC B. VALERA

Governor
GENERAL REQUIREMENTS DOCUMENTARY REQUIREMENTS
1. Must be a Filipino citizen and a resident of Abra 1. Duly accomplished DADS EAP Application Form
2. Must be an indigent college student in any school in the 2. Certificate of Indigency from the barangay
province 3. Certificate of Enrollment
3. Must not be a graduate of any degree program 4. School I.D.